NON-GONORRHCEAL URETHRITIS 



1943 



may appear, the fever is of an intermittent or remittent type, the 

 pulse becomes extremely small, there is often hiccough, and the 

 patient dies in a few days. 



Varieties. — A mild form, with thrombosis of the veins, but without 

 suppuration, is at times met with. According to Coutts, a chronic 

 form, also without suppuration, may occur. 



Prognosis. — This is serious in the ordinary acute form. If an 

 operation is not performed in time, symptoms of general septicaemia 

 set in, and the case, as a rule, ends fatally. 



Diagnosis. — The disease is apt to be confused with strangulated 

 hernia and an acute elephantoid condition of the testicle and cord. 

 From the former endemic funiculitis may be differentiated by the 

 history, the high fever, and the course, which is somewhat less acute. 

 In some cases, especially in the fulminating forms, operative treat- 

 ment alone will clear the diagnosis. 



From an acute elephantoid condition it may be differentiated by 

 the absence of the erysipelatous-like redness of the skin. 



Treatment. — Except in the rare mild forms, when lead lotion and 

 ichthyol ointment, withor without ice application, maybe sufficient, 

 the only effective treatment is surgical, and orchiotomy, with 

 section of the inflamed cord as high up as possible, is imperative. 

 Coutts recommends exposure of the inflamed cord by a free in- 

 cision through the skin and external oblique, to be followed by 

 numerous incisions into the tumour. The wound is left open, and 

 fomentations applied till the surface is clean. The wound is then 

 left to heal by granulation. Coutts considers that in this way, 

 though the testis loses its generative function owing to the oblitera- 

 tion of the spermatic duct caused by the inflammation, its internal 

 secretion is unimpaired. 



When the disease has extended beyond the internal abdominal 

 ring, orchiotomy must be performed and the veins left unligatured 

 while fomentations are applied. 



NON-GONORRHOEAL URETHRITIS. 



Urethral muco-purulent discharge is as a rule of gonorrhoea! origin, but 

 Castellani has called attention to a number of forms of quite different aetiology, 

 which may be classified as follows : — 



A. Traumatic Mucous Urethritis. 



This occasionally arises after long and violent continued physical exercise. 

 One is rather sceptical in admitting such a type of urethritis, and practically 

 all the cases of so-called * porter's urethritis ' we have seen were gonorrhceal 

 infections. Still, there cannot be any doubt that in soldiers and native porters 

 doing long marches day after day a slight urethritis with scanty mucous 

 discharge may occasionally develop, even in individuals who have never 

 suffered in the past from gonorrhoea. The secretion, however, in our ex- 

 perience is never frankly purulent. 



B. Urethritis of Hyphomycetic Origin. 



The following clinical varieties may be difierentiated : — 



I. The discharge is black, greenish-black, or brownish-black, generally due 



